In pure self-insurance, an employer sets aside the money necessary to pay for all future losses. The amount of money necessary is calculated using actuarial information, insurance data, and the “law of large numbers” to
calculate the probability of loss and the cost of expected incurred losses. If the employer does not have the available capital to place in reserve for future losses, self-insurance is not a viable approach to controlling risk.
Self-insurance for workers compensation benefits the employer in several ways, including:
1. Lowering the overall cost of insuring for risk. The portion of the insurance premium that would be the profit for both the broker and the insurance company is retained by the employer. The amount of money set aside for the self-insured risk is used for paying claims and administering the claims management program.
2. Providing better claims management. The claims can be either self-handled or administered by a third party administrator (TPA) where the TPA adjusters follow the directions and suggestions of the self-insured employer. It gives the employer more control over the claims handling situation. (WCxKit)
3. Lower claim cost and claim adjusting expenses. The TPA, especially a local and or regional TPA, can be flexible in designing and pricing the claims administration services.
4. Self-insured employers also have a vested interest in the return-to-work program, ergonomics of the workplace, and having integrated safety programs.
With the benefits of self-insurance, you would think all employers would want to self-insure workers compensation. The barrier most employers run into is the ability to self-insure for catastrophic losses. While many employers can set aside money for routine, day-to-day workers
comp claims, the actuarial determination of the amount of money necessary to set aside for catastrophic losses is more difficult to ascertain. Often the employer can place into reserves the amount of money for one catastrophic loss; but what happens if the employer has multiple catastrophic workers comp claims?
Full self-insurance is seldom possible. For a company to be fully self-insured in a viable manner, they must be able to cover all future losses, even the remote possibility of multiple
catastrophic losses. Often employers elect to either have a self-insured retention or a high deductible, or a combination of the two.
To be “self-insured” but also cover the exposure for catastrophic claims, employers often determine the level of self-insurance they can afford. The company then purchases excess insurance to cover the risk of loss over and above a specific threshold. For instance, with a self-insurance retention, the employer administers and pays all claims under a set dollar amount. For an example, $500,000. When the total cost of the claims exceeds $500,000, the excess insurer reimburses the portion of the claims over $500,000.
Another approach for a self-insured employer unable to set aside the necessary reserves for catastrophic claims, is a large deductible program. In a large deductible program the employer purchases a policy of insurance from an insurance company. The employer is responsible for reimbursing the insurance company for each claim in the policy period up to a dollar limit. The employer will also have a maximum amount of exposure for all claims combined.
To illustrate: the employer reimburses the insurance company the total amount paid on each claim under $500,000 (the large deductible amount), but when the insured pays a total of $2,500,000 (a stop-loss limit) on all claims, the insurance company takes over and pays all further claim costs during the policy period. The allocated loss adjustment expense (the cost of handling the claim) is often included in the claim cost in the large deductible program. (WCxKit)
Self-insurance can be an excellent way to reduce the overall cost of insurance. Properly designed and administered, a self-insurance program can have a significant positive impact for the employer.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
Our WC Manual is the BEST: www.WCBook.us
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
The U.S. Equal Employment Opportunity Commission (EEOC) has sued a national insurer claiming the firm violated federal law by refusing to hire a North Carolina man after he disclosed he was participating in a methadone treatment program for drug addiction.
The suit was filed in U.S. District Court in Raleigh against United Insurance Co. of America, according to EEOC attorney Lynette Barnes. (WCxKit)
The complaint argues the firm violated federal disability discrimination law by refusing to hire Craig Burns, 30, who applied for a job in the firm’s Raleigh office in December of 2009. The firm made a conditional offer of employment to Burns the following month, depending upon his passing a drug test.
The test showed the presence of methadone in his system, so Burns submitted a letter to the firm from his treatment provider saying he was participating in a supervised methadone treatment program and taking legally prescribed medication as part of the treatment, the complaint said. Upon receiving this information, United Insurance notified Barnes he was not eligible to be hired and withdrew the employment offer.
According to Barnes, the action violates the Americans with Disabilities Act, which protects employees and applicants from discrimination based on their disabilities. A recovering drug addict is covered under the act. (WCxKit)
The suit seeks back pay, compensation for financial loss, along with punitive damages.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
A Railcorp employee has been found guilty of workers compensation fraud, was ordered to repay $32,540, and was fined $10,800 after a New South Wales (Australia) WorkCover investigation found he had an undeclared second job while receiving benefits for being too injured to carry out his first job.
According to a report from NSW WorkCover Authority, Varinder Sandhu, a 35-year-old train driver from South Wentworthville, allegedly injured his lower back when shunting train carriages.(WCxKit)
RailCorp accepted liability for the injury and Sandhu received weekly compensation totaling $32,540 while allegedly unfit for work for a period of six months.
During this time it became clear the man had a second job as a migration agent and was in fact advertising his services in the media.
At no time did Sandhu inform RailCorp that he was working as a registered migration agent or inform them he had a second job.
The court ordered the man to repay the $32,540 he had fraudulently received in compensation, fined him $10,800 and also ordered him to pay WorkCover’s legal costs. RailCorp has since terminated the man’s employment.
WorkCover’s acting general manager of the workers compensation division, Mary Hawkins, said workers comp fraud was a serious offence and Sandhu had clearly breached the law and lied to his employer on numerous occasions.
“WorkCover and the Workers Compensation System, helps injured workers usually at times of great need,” Hawkins said.(WCxKit)
“It is unconscionable that someone would attempt to so blatantly bring the workers compensation system into disrepute. Employers pay their premiums to ensure workers injured during the course of their employment receive the right level of care and income support while unable to work. It is essential that all participate in the system act honestly so that the scheme remains affordable and workers are cared for appropriately,” she said.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Being a claims professional has a lot of demands. Everyday you have to juggle multiple demands on many files, sometimes within several jurisdictions. A typical caseload for the lost-time adjuster is 150 active files. The adjuster tries to handle the demands of those files in addition to the phone calls, emails, and medical records, usually without any support staff.
Every adjuster appreciates anything that helps make their job easier. Below we discuss six small items that can make a big difference to Joe (or Josephine) Claims Adjuster.(WCxKit)
1. Please complete all fields on the injury form.
When an adjuster first gets a new assignment, nothing makes them more frustrated than to see many fields missing information. This can include social security numbers, birth dates, the type of injury, the date the injury was reported to the supervisor, etc. All of these fields are equally important, and when any are empty it means another phone call to the contact at the insured to gather this information. Take the time to complete all fields, so the adjuster has the information needed to get started on the file investigation without delay.
NOTE TO EMPLOYERS: IF YOU LEAVE BLANK FIELDS, SOMEONE ELSE MAY FILL THEM IN – WITH ANSWERS THAT YOU WON'T LIKE. Attach information if there isn't enough room for the complete answer. Staple it and mail a copy to the adjuster.
2. Report All Claims in a Timely Manner.
The next thing that annoys adjusters are late claims. Depending on the jurisdiction, this can put the adjuster in a time crunch to gather as much claims information to complete the investigation, and the fact they are rushing can lead to errors, or even worse, leakage. The last thing anyone wants is money and time wasted on a claim that is not compensable. One of the best things you can do is to report a claim right away. Do not let it sit on your desk until the injured worker goes in for surgery the next day. The sooner you can get that injury report to your adjuster, the better chance they will have to do a proper, thorough investigation. This leads to correct, ethical decisions on your claims without delays, penalties, or leakage.
3. Let the adjuster know if there is lost time on a claim.
Claims that include lost wages carry a certain priority with the adjuster, since every day that clicks by means another day of potential wage loss due to the employee. As mentioned above, injuries should be reported right away. This gives the adjuster time to gather medical records to see if the claim is compensable. It also gives the adjuster a chance to get work restrictions on your employee so they can be placed in your light-duty work program. This eliminates the need for lost wages paid to the employee and keeps your claim costs down. When injuries are reported right away, everyone wins. The employee gets prompt contact by the adjuster, the adjuster gets a jump on the claim, and the employer gets to keep their costs down as low as possible.
4. Don't tell the adjuster if a claim is compensable or not. It bugs them.
As much as you think a claim is legit or not, the employer typically cannot make a decision on a claim’s compensability. This is the adjuster’s job — what they get paid to do. This is why they are licensed to be claims adjusters in your state. They have the training and certification to make the decision on compensability. It is really important to voice your opinion on the claim, and to be able to back up your assumptions with facts. This will greatly help the adjuster with their investigation, but the overall decision on if the claim is accepted or not should be left up to the adjuster. Plus some jurisdictions have steep fines if claims are denied in error, so why put yourself in that position? Leave it up to the claims professionals. IF IT IS NOT A LEGITIMATE CLAIM – TELL THEM YOU SUSPECT FRAUD. PUSH IT- so you are taken seriously. I don't always live by my own advise here, and I almost always give my opinion about what I think is compensable, or not…
5. Make yourself accessible to the adjuster and return calls as soon as possible.
Claims adjusters have to make many phone calls every day. They are constantly on the phone. If they are calling you to get facts on an injury, and they leave you a message to call them, please call them back as soon as you can. Employer input on claims is important. Bear in mind you see your employees every day. You know a lot about them that the claim adjusters do not. Your investigation is just as important to the adjuster as is theirs. They rely on you heavily to know about the injury, what happened, why it happened, and what happened after the worker left. Send them any medical information you have, as this also will give them the provider’s name, address, contact info, and initial diagnosis. If you get bills for the treatment from the provider send them to the adjuster so they can be processed for payment if the claim is compensable. Anything you get that involves the claim should be sent to the adjuster, no matter what it is. The adjuster would always rather have more information than not enough.
6. Know the details of the injury soon after it happened.
The first question the adjuster will ask you when they call is, “What happened?” Adjusters hate to hear the answer, “I do not know.” Obviously this does not help the adjuster. You should be heavily involved in any claim that occurs at your workplace, whether it is a work comp injury, a liability injury, or a property damage claim. Gather facts and witness statements to send to the adjuster. Comments the witnesses have can impact a claim because the adjuster will compare that to the history given to them by the injured worker, and what history the injured worker gave the doctor when they were first examined in a medical facility. Any facts that do not add up will raise the red flag that there may be something more to this claim than what is on the surface, and it could prevent a claim from being falsely accepted. This again will keep your costs down, since you will not incur the leakage associated with paying a claim in error.(WCxKit)
In conclusion, these are 6 items that can greatly help the adjuster, even though you as the employer may find them quite trivial. You would be surprised if you saw the amount of information adjusters have to process on their 150-200 claims each day. Every little bit of information to the adjuster helps them out, and makes their job easier. It all leads to the same goal that we have in claims, which is to properly investigate every one so the appropriate decision can be made on the compensability.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Tube Union RMT recently warned that London Underground is on the verge of plunging the Capital’s tube system into the same lethal cocktail of safety cuts and automation that led to nine people being killed on the Washington D.C. Red Line service just over two years ago.
Recently, the TFL Board was to discuss a document entitled London Underground's “operational vision”, which flags up a future of driverless trains and de-staffing of platforms and stations to save money. (WCxKit)
RMT leaked the details of the plans recently despite protests from TFL that they were merely “blue sky thinking”. Only days later, the same plans were confirmed as the core operational strategy.
Recently, there has been much talk of automated systems already operating. One such was the 35-year-old Washington D.C. metro, which switched to manual operation in the wake of a horrific rush-hour crash in June 2009, which killed nine people, including the operator.
The collision was caused by failure of the automated system, and the
Washington Post called it the “price of parsimony” after numerous near-misses went unheeded against a background of cuts to maintenance schedules and inspections – exactly the same cuts-led culture now being imposed by LU.
RMT General Secretary Bob Crow noted, “We need no more evidence of what happens when cuts-led automation and changes to maintenance are imposed from above than the tragedy on the Washington DC Red Line in June 2009.
“The same lethal combination of cuts and automation is now at the core of LU’s strategic thinking and RMT will mount the fiercest opposition to these politically motivated plans that have more to do with next year’s Mayoral election than they do with providing a safe transport service for London. (WCxKit)
“RMT has already exposed attempts to tamper with the inspection schedules for the failsafe tripcocks and other cuts to maintenance schedules. This dicing with death on the London Underground has to stop before we have a major disaster on our hands.”
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
The U.S. Department of Labor's Occupational Safety and Health Administration recently cited Callaway Contracting Inc. of Jacksonville for 13 safety violations. According to a report from OSHA, it opened an inspection in May following the death of a worker who was electrocuted while unloading steel from a tractor trailer for a roadway rehabilitation project on Normandy Boulevard. The inspection also was expanded to include the company's main office on New Berlin Road.
"This fatality could have been prevented. Management knew about the hazards associated with unloading the truck near power lines, but rushed to get the truck unloaded and failed to take the proper precautions," said Brian Sturtecky, OSHA's area director in Jacksonville. (WCxKit)
Callaway, an underground utility contractor, was cited for one willful violation related to the fatality for failing to prevent the load line from contacting the energized overhead power lines. Three other willful violations involve failing to have a qualified person inspect the crane annually and exposing workers to being caught in a rotating superstructure, as well as "struck by" hazards. A willful violation is one committed with intentional knowing or voluntary disregard for the law's requirements, or with plain indifference to worker safety and health.
Eight serious violations involve failing to train employees on procedures to be followed in the event the crane makes contact with power lines, failing to conduct daily inspections of the crane prior to its use, ensuring that the crane's operating manual is readily available inside the cab, adequately training the crane operator, training and designating a signal person, and bolting the drill press to the floor. The employer was cited for exposing employees to flying chips of metal, electrical shocks and being drawn into the point-of-operation of equipment. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.
One other-than-serious violation was cited, with no monetary penalty, for exposed electrical wires. An other-than-serious violation is one that has a direct relationship to job safety and health, but probably would not cause death or serious physical harm.
Proposed penalties total $208,670. Callaway has 15 business days from receipt of the citations and proposed penalties to comply, request a conference with OSHA's area director or contest the findings before the independent Occupational Safety and Health Review Commission.
OSHA has placed Callaway in its Severe Violator Enforcement Program, which mandates targeted follow-up inspections to ensure compliance with the law. Initiated in June 2010, the program focuses on recalcitrant employers that endanger workers by committing willful, repeat or failure-to-abate violations.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Texas Mutual Insurance Company recently reported that a Travis County district court sentenced Derrick Crockrom of Houston on workers compensation fraud-related charges.
Crockrom was sentenced to 15 days in jail and two years’ deferred adjudication. He was also ordered to complete 50 hours of community service. Crockrom reported a job-related injury while working as a driver for Best Delivery Systems, Inc. of Houston. He claimed he was unable to work as a result of the injury, and Texas Mutual began paying income benefits to him.(WCxKit)
Meanwhile, Texas Mutual uncovered evidence Crockrom was working as a broker for a Houston financial company while at the same time receiving income benefits.
Investigators call this type of scam double-dipping because the claimant collects benefits for being too injured to work when he or she is, in fact, gainfully employed. Texas law requires claimants to contact their workers’ comp carrier when they return to work. (WCxKit)
Left unchecked, double-dipping and other workers comp fraud can lead to higher premiums for all Texas employers.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
A Burnaby, British Columbia-based mining company has pleaded guilty to two occupational health and safety charges stemming from a fatal workplace accident in Yukon..
According to the Canadian OH&S News, a 20-year-old apprentice mechanic employed by Procon Mining and Tunneling Ltd. was working at Yukon Zinc Corporation's Wolverine Mine site south of Ross River. While driving his 2004 Toyota Land Cruiser down a 15 percent decline to deliver a part for a piece of equipment to another worker, Paul Wentzell came upon another piece of equipment parked on the ramp. He stopped, pushed the Land Cruiser's emergency brake actuation button on the dashboard (but not the regular parking brake), left the truck in neutral and walked toward the parled equipment. (WCxKit)
The emergency brake did not hold and the vehicle rolled down the decline, striking the young worker from behind, causing serious internal injuries according to a preliminary investigation report into the accident. The vehicle came to a stop approximately 20 meters from where it was originally parked when it collided with the second piece of equipment.
Almost two years after the incident, Procon Mining and Tunneling pleaded guilty to two charges, according to Frank Fry, a spokesman for the Yukon Workers Compensation Health and Safety Board. In particular, the charges relate to the failure to ensure that the emergency brakes on the Toyota Land Cruiser were maintained in a safe operating condition and failure to ensure that a worker had demonstrated competence in operating the vehicle to a supervisor or qualified person.
Six other charges have been stayed, Fry said. This means these counts could be revisited within a year. The charges relate to the alleged failure to:
1. ensure the vehicle was properly identified when unsafe for use;
2. inspect, repair or maintain a braking system in accordance with good engineering practice;
3. inspect the vehicle's braking system within its 250-hour maintenance schedule;
4. ensure the worker had received adequate training in the safe use and operation of the Land Cruiser;
5. ensure the worker was under direct supervision when operating mobile equipment; and,
6. ensure the emergency brake actuation control was identified to show the function it served.
Fry said in the territory the fine for a first offense is up to a maximum of $150,000 and up to $300,000 for subsequent penalties. Procon Mining and Tunneling will appear in court for its sentencing hearing. (WCxKit)
Mine owner Yukon Zinc Corporation is not facing any charges in connection with the incident. "Only Procon was charged because the safety issues involved with the fatality were related directly to that company's operations and did not involve any aspects of the mine's operations," Fry added.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
The cost of medical care is the largest part of the total cost of workers compensation. Finding ways to control and manage these medical costs is important to maintain and control workers
compensation cost. There are numerous techniques to use to control medical costs.
Let us look at the ones providing the most benefit to the employer:
1. Nurse Case Managers
The most important person in the control of
workers comp medical costs is the
Nurse Case Manager (NCM). The NCM is responsible for planning and coordinating medical care to assist the employee in returning to work as soon as physically able or when the employee reaches the maximum medical improvement (MMI). The NCM role can either be in the office handling most communications by telephone — a telephonic case manager (TCM); or the nurse can spend most of her (or his) time away from the office – a field case manager (FCM) who attends medical appointments with the injured employee. (WCxKit)
Whether the nurse is referred to as a NCM, TCM, or FCM, the role is to make sure the employee receives all necessary medical care as quickly as possible. The
responsibilities of the NCM include:
1. Consulting with the medical providers on the best options for treating the employee.
2. Coordinating the medical care between the different medical providers.
3. Preventing the over utilization of medical care while ensuring the employee receives all needed care.
4. Acting as a liaison between the employee, employer, physician, therapist, insurer, and other parties.
5. Facilitating the communications between the employee, employer, and adjuster.
6. Arranging the employee's return to work either in modified duty with the necessary accommodations or full duty without any accommodations.
7. Keeping the adjuster and employer informed as to the employee's medical status.
2. Medical Provider Networks
When various medical providers including doctors, hospitals, physical therapists, and others join together for the purpose of providing medical care to a specific group (employees), a medical
provider network is formed. In exchange for sending all injured employees to the medical provider network, the employers or insurers receive a group discount on the
cost of medical care. California and Texas are the two biggest states where medical provider networks are utilized to control the cost of workers compensation. Follow the rules exactly, and you can direct care for the life of the claim in California. In California, these are called MPNs.
3. Medical Triage
Medical triage is the process of having a trained nurse arrange the medical care for any employee who reports an injury. The triage nurse coordinates the medical care for the employee, arranges for the initial medical visit and any follow up visit, and advises the adjuster on the nature of the injury and the type of initial care received by the employee. Approximately 40% of your claims will be "self care" claims, which means you'll have 40% fewer claims, many of which would have ultimately become lost time claims. It's a way to stay on the claim from Day 1. Nurse triage can even direct the employee (and supervisor) to the nearest PPO in your network – if allowed by state law.
4. Utilization Reviews
Utilization review is the review of medical care by another party other than the medical provider to ensure the appropriateness of the medical care. There are three types of utilization review.
1. Pre-certification: the requested medical service whether hospitalization, surgery or diagnostic testing, is reviewed by a trained nurse or doctor, to verify it is the best medical approach for the injured employee's medical care, before the medical care is provided.
2. Concurrent reviews: occurs when the employee is in the hospital is having any other medical care that takes enough time for the medical necessity to be checked before it is completed.
3. Retrospective reviews: verifies the need for medical services already provided.
5. Medical Fee Schedules
In an effort to control medical costs, most states place a dollar cap on each type of medical service an employee can receive following an injury. A medical bill review company compares all medical bills submitted against the fee schedule to insure only appropriate services are billed and billed for the correct amount. Most states have their own fee schedules – which is generally a very large, complex list (like a phone book) of codes for each injury/illness and treatment.
6. Pharmacy Benefit Managers
Pharmacy benefit managers (PBM) specialize in providing the employee with needed prescription medications. The PBM arranges for the employee to obtain prescriptions at drug stores within the network, or provides to the employee, by mail, any maintenance medications the employee will take over an extended period of time. PBMs can help control the overuse of prescription medication and curb opioid abuse.
7. Medical Panels
Several states allow the employer to designate a list of medical providers the employee can select from when the employee is injured. This panel of doctors includes a variety of medical specialties and/or medical facilities. The medical panel is normally posted at the employee's work site for the employee to chose from. This is sort of a blend between employee selects their own provider and employer selects the provider. Which ever state/s you are in make sure you know how medical provider selection is done.
8. Independent Medical Evaluations (IME)
An independent medical examination is a second opinion from a doctor selected by the insurance company to confirm the diagnosis and treatment of the employee. It can also be used to verify the disability or impairment of an employee when the employee finishes medical care. (WCxKit) Have an MD write the IME cover letter and point out to the IME doctor relevant causation issues and/or mechanism of injury issues that make be disproportionate to the injury. Why get an IME if it's not going to be preceded/set up with an effective cover letter?
These 8 approaches are not the only ways to control medical costs in your workers compensation claims. There are various other techniques that can be used to limit medical costs and additional approaches are being developed as more and more employers look for ways to control these costs.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
The European Transport Safety Council (ETSC) reports that it has launched a new call for entries in its third annual competition on work related road safety.
“I hope this award will motivate employers to take on the challenge and reap the benefits of managing road safety as an integral part of their working practice. Introducing road safety measures makes good business sense, particularly in a tough economic climate when employers should want to cut the costs of collisions in their vehicle fleets,” said Antonio Avenoso, ETSC executive director. (WCxKit)
The competition is part of the ETSC project: Preventing Road Accidents and Injuries for the Safety of Employees (PRAISE). PRAISE aims to increase road safety in the work context and “praise” best practices in order to help employers secure high road safety standards for their employees.
Part of the project is a competition which aims to spur on companies throughout the EU to tackle road safety at work. ETSC is searching for entrants who can demonstrate what they have achieved through their efforts to reduce collisions at work and/or while commuting to and from work. ETSC’s panel of judges will evaluate entrants based on a number of criteria including evidence of progress, innovation and lasting efforts. The ‘PRAISE Awards are presented annually at the PRAISE Brunch to employers identified for responsibly taking on the road safety challenge.
Previous winners include British Telecom, the Irish Electricity Supply Board and KTL4.
There are two separate categories in the competition: one for SMEs (Small-Medium Enterprise) and one category for larger employers.
Employers rewarded by PRAISE will receive positive recognition for their efforts made in road safety and press coverage. Moreover, they will have the opportunity to exchange best practice with other companies committed to road safety thus creating new business opportunities.
Finally, ETSC hopes that employer’s commitment to work-related road safety will increase by receiving recognition for their efforts. (WCxKit)
Employers who wish to apply to receive the award can find all relevant information and an electronic application form at: http://www.etsc.eu/PRAISE-award.php.
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
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